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General NPI Number Information
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NPI Number | 1801221403
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Entity Type | Organization
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Legal Business Name | DOCRX, INC.
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 4200 WILLIAMSON PL
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6705
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Country | US
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Telephone | 618-242-1400
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Fax | 618-248-3907
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Provider Business Mailing Address
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Address Line | 4636 BIT AND SPUR RD STE A
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City | MOBILE
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State | AL
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Zip | 36608-2646
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN WARD
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Credential |
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Telephone | 251-605-4271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036039250
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License Number State | IL
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